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Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections
INTRODUCTION: Measurement of prohormones representing different pathophysiological pathways could enhance risk stratification in patients with community-acquired pneumonia (CAP) and other lower respiratory tract infections (LRTI). METHODS: We assessed clinical parameters and five biomarkers, the pre...
Autores principales: | , , , , , , , , , , , , , , , , , , |
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Formato: | Texto |
Lenguaje: | English |
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BioMed Central
2010
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911752/ https://www.ncbi.nlm.nih.gov/pubmed/20529344 http://dx.doi.org/10.1186/cc9055 |
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author | Schuetz, Philipp Wolbers, Marcel Christ-Crain, Mirjam Thomann, Robert Falconnier, Claudine Widmer, Isabelle Neidert, Stefanie Fricker, Thomas Blum, Claudine Schild, Ursula Morgenthaler, Nils G Schoenenberger, Ronald Henzen, Christoph Bregenzer, Thomas Hoess, Claus Krause, Martin Bucher, Heiner C Zimmerli, Werner Mueller, Beat |
author_facet | Schuetz, Philipp Wolbers, Marcel Christ-Crain, Mirjam Thomann, Robert Falconnier, Claudine Widmer, Isabelle Neidert, Stefanie Fricker, Thomas Blum, Claudine Schild, Ursula Morgenthaler, Nils G Schoenenberger, Ronald Henzen, Christoph Bregenzer, Thomas Hoess, Claus Krause, Martin Bucher, Heiner C Zimmerli, Werner Mueller, Beat |
author_sort | Schuetz, Philipp |
collection | PubMed |
description | INTRODUCTION: Measurement of prohormones representing different pathophysiological pathways could enhance risk stratification in patients with community-acquired pneumonia (CAP) and other lower respiratory tract infections (LRTI). METHODS: We assessed clinical parameters and five biomarkers, the precursor levels of adrenomedullin (ADM), endothelin-1 (ET1), atrial-natriuretic peptide (ANP), anti-diuretic hormone (copeptin), and procalcitonin in patients with LRTI and CAP enrolled in the multicenter ProHOSP study. We compared the prognostic accuracy of these biomarkers with the pneumonia severity index (PSI) and CURB65 (Confusion, Urea, Respiratory rate, Blood pressure, Age 65) score to predict serious complications defined as death, ICU admission and disease-specific complications using receiver operating curves (ROC) and reclassification methods. RESULTS: During the 30 days of follow-up, 134 serious complications occurred in 925 (14.5%) patients with CAP. Both PSI and CURB65 overestimated the observed mortality (X(2 )goodness of fit test: P = 0.003 and 0.01). ProADM or proET1 alone had stronger discriminatory powers than the PSI or CURB65 score or any of either score components to predict serious complications. Adding proADM alone (or all five biomarkers jointly) to the PSI and CURB65 scores, significantly increased the area under the curve (AUC) for PSI from 0.69 to 0.75, and for CURB65 from 0.66 to 0.73 (P < 0.001, for both scores). Reclassification methods also established highly significant improvement (P < 0.001) for models with biomarkers if clinical covariates were more flexibly adjusted for. The developed prediction models with biomarkers extrapolated well if evaluated in 434 patients with non-CAP LRTIs. CONCLUSIONS: Five biomarkers from distinct biologic pathways were strong and specific predictors for short-term adverse outcome and improved clinical risk scores in CAP and non-pneumonic LRTI. Intervention studies are warranted to show whether an improved risk prognostication with biomarkers translates into a better clinical management and superior allocation of health care resources. TRIAL REGISTRATION: NCT00350987. |
format | Text |
id | pubmed-2911752 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2010 |
publisher | BioMed Central |
record_format | MEDLINE/PubMed |
spelling | pubmed-29117522010-07-29 Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections Schuetz, Philipp Wolbers, Marcel Christ-Crain, Mirjam Thomann, Robert Falconnier, Claudine Widmer, Isabelle Neidert, Stefanie Fricker, Thomas Blum, Claudine Schild, Ursula Morgenthaler, Nils G Schoenenberger, Ronald Henzen, Christoph Bregenzer, Thomas Hoess, Claus Krause, Martin Bucher, Heiner C Zimmerli, Werner Mueller, Beat Crit Care Research INTRODUCTION: Measurement of prohormones representing different pathophysiological pathways could enhance risk stratification in patients with community-acquired pneumonia (CAP) and other lower respiratory tract infections (LRTI). METHODS: We assessed clinical parameters and five biomarkers, the precursor levels of adrenomedullin (ADM), endothelin-1 (ET1), atrial-natriuretic peptide (ANP), anti-diuretic hormone (copeptin), and procalcitonin in patients with LRTI and CAP enrolled in the multicenter ProHOSP study. We compared the prognostic accuracy of these biomarkers with the pneumonia severity index (PSI) and CURB65 (Confusion, Urea, Respiratory rate, Blood pressure, Age 65) score to predict serious complications defined as death, ICU admission and disease-specific complications using receiver operating curves (ROC) and reclassification methods. RESULTS: During the 30 days of follow-up, 134 serious complications occurred in 925 (14.5%) patients with CAP. Both PSI and CURB65 overestimated the observed mortality (X(2 )goodness of fit test: P = 0.003 and 0.01). ProADM or proET1 alone had stronger discriminatory powers than the PSI or CURB65 score or any of either score components to predict serious complications. Adding proADM alone (or all five biomarkers jointly) to the PSI and CURB65 scores, significantly increased the area under the curve (AUC) for PSI from 0.69 to 0.75, and for CURB65 from 0.66 to 0.73 (P < 0.001, for both scores). Reclassification methods also established highly significant improvement (P < 0.001) for models with biomarkers if clinical covariates were more flexibly adjusted for. The developed prediction models with biomarkers extrapolated well if evaluated in 434 patients with non-CAP LRTIs. CONCLUSIONS: Five biomarkers from distinct biologic pathways were strong and specific predictors for short-term adverse outcome and improved clinical risk scores in CAP and non-pneumonic LRTI. Intervention studies are warranted to show whether an improved risk prognostication with biomarkers translates into a better clinical management and superior allocation of health care resources. TRIAL REGISTRATION: NCT00350987. BioMed Central 2010 2010-06-08 /pmc/articles/PMC2911752/ /pubmed/20529344 http://dx.doi.org/10.1186/cc9055 Text en Copyright ©2010 Schuetz et al.; licensee BioMed Central Ltd http://creativecommons.org/licenses/by/2.0 This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Research Schuetz, Philipp Wolbers, Marcel Christ-Crain, Mirjam Thomann, Robert Falconnier, Claudine Widmer, Isabelle Neidert, Stefanie Fricker, Thomas Blum, Claudine Schild, Ursula Morgenthaler, Nils G Schoenenberger, Ronald Henzen, Christoph Bregenzer, Thomas Hoess, Claus Krause, Martin Bucher, Heiner C Zimmerli, Werner Mueller, Beat Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections |
title | Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections |
title_full | Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections |
title_fullStr | Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections |
title_full_unstemmed | Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections |
title_short | Prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections |
title_sort | prohormones for prediction of adverse medical outcome in community-acquired pneumonia and lower respiratory tract infections |
topic | Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2911752/ https://www.ncbi.nlm.nih.gov/pubmed/20529344 http://dx.doi.org/10.1186/cc9055 |
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